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Lower Gastrointestinal Bleeding

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Common Problems in Acute Care Surgery

Abstract

The lower gastrointestinal tract consists of all gastrointestinal elements distal to the ligament of Treitz, including the jejunum, ileum, cecum, appendix, colon, rectum, and anus. Lower gastrointestinal bleeding can originate from any of these locations and thus represents a broad range of clinical entities. Most studies of lower gastrointestinal hemorrhage specifically reference lesions of the colon, rectum, and anus, and the majority of studies cited herein adhere to this convention.

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References

  1. Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90:206–10.

    PubMed  CAS  Google Scholar 

  2. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92(3):419–24. Research Support, Non-U.S. Gov’t.

    PubMed  CAS  Google Scholar 

  3. Peura DA, Lanza FL, Gostout CJ, Foutch PG. The American College of Gastroenterology Bleeding Registry: preliminary findings. Am J Gastroenterol. 1997;92(6):924–8. Research Support, Non-U.S. Gov’t.

    PubMed  CAS  Google Scholar 

  4. Strate LL, Saltzman JR, Ookubo R, Mutinga ML, Syngal S. Validation of a clinical prediction rule for severe acute lower intestinal bleeding. Am J Gastroenterol. 2005;100(8):1821–7. Research Support, Non-U.S. Gov’t Validation Studies.

    Article  PubMed  Google Scholar 

  5. Strate LL, Orav EJ, Syngal S. Early predictors of severity in acute lower intestinal tract bleeding. Arch Intern Med. 2003;163(7):838–43. Research Support, U.S. Gov’t, P.H.S.

    Article  PubMed  Google Scholar 

  6. Velayos FS, Williamson A, Sousa KH, Lung E, Bostrom A, Weber EJ, et al. Early predictors of severe lower gastrointestinal bleeding and adverse outcomes: a prospective study. Clin Gastroenterol Hepatol. 2004;2(6):485–90. Research Support, Non-U.S. Gov’t.

    Article  PubMed  Google Scholar 

  7. Vernava 3rd AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997;40(7):846–58. Review.

    Article  PubMed  Google Scholar 

  8. Whitlow CB. Endoscopic treatment for lower gastrointestinal bleeding. Clin Colon Rectal Surg. 2010;23(1):31–6.

    Article  PubMed  Google Scholar 

  9. Hoedema RE, Luchtefeld MA. The management of lower gastrointestinal hemorrhage. Dis Colon Rectum. 2005;48(11):2010–24. Review.

    Article  PubMed  Google Scholar 

  10. Edelman DA, Sugawa C. Lower gastrointestinal bleeding: a review. Surg Endosc. 2007;21(4):514–20. Review.

    Article  PubMed  Google Scholar 

  11. Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol. 2001;96(8):2367–72.

    Article  PubMed  CAS  Google Scholar 

  12. Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg. 1986;204:530–6.

    Article  PubMed  CAS  Google Scholar 

  13. Leitman IM, Paull DE, Shires 3rd GT. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989;209(2):175–80.

    Article  PubMed  CAS  Google Scholar 

  14. Cuellar RE, Gavaler JS, Alexander JA, Brouillette DE, Chien MC, Yoo YK, et al. Gastrointestinal tract hemorrhage. The value of a nasogastric aspirate. Arch Intern Med. 1990;150(7):1381–4. Research Support, U.S. Gov’t, P.H.S.

    Article  PubMed  CAS  Google Scholar 

  15. Graham DJ, Pritchard TJ, Bloom AD. Colonoscopy for intermittent rectal bleeding: impact on patient management. J Surg Res. 1993;54(2):136–9.

    Article  PubMed  CAS  Google Scholar 

  16. Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: hemorrhagic shock. Crit Care. 2004;8(5):373–81. Review.

    Article  PubMed  Google Scholar 

  17. Allison JE, Tekawa IS, Ransom LJ, Adrain AL. A comparison of fecal occult-blood tests for colorectal-cancer screening. N Engl J Med. 1996;334(3):155–9. Comparative Study Research Support, Non-U.S. Gov’t.

    Article  PubMed  CAS  Google Scholar 

  18. Friedman A, Chan A, Chin LC, Deen A, Hammerschlag G, Lee M, et al. Use and abuse of faecal occult blood tests in an acute hospital inpatient setting. Intern Med J. 2010;40(2):107–11. Comparative Study Multicenter Study.

    Article  PubMed  CAS  Google Scholar 

  19. Sinatra MA, St John DJ, Young GP. Interference of plant peroxidases with guaiac-based fecal occult blood tests is avoidable. Clin Chem. 1999;45(1):123–6. Comparative Study Research Support, Non-U.S. Gov’t.

    PubMed  CAS  Google Scholar 

  20. Strate LL. Lower GI, bleeding: epidemiology and diagnosis. Gastroenterol Clin North Am. 2005;34(4):643–64. Research Support, N.I.H., Extramural Review.

    Article  PubMed  Google Scholar 

  21. Al Qahtani AR, Satin R, Stern J, Gordon PH. Investigative modalities for massive lower gastrointestinal bleeding. World J Surg. 2002;26(5):620–5. Evaluation Studies.

    Article  PubMed  Google Scholar 

  22. Tada M, Shimizu S, Kawai K. Emergency colonoscopy for the diagnosis of lower intestinal bleeding. Gastroenterol Jpn. 1991;26 Suppl 3:121–4.

    PubMed  Google Scholar 

  23. Vellacott KD. Early endoscopy for acute lower gastrointestinal haemorrhage. Ann R Coll Surg Engl. 1986;68(5):243–4.

    PubMed  CAS  Google Scholar 

  24. Damore 2nd LJ, Rantis PC, Vernava 3rd AM, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum. 1996;39(11):1308–14. Review.

    Article  PubMed  Google Scholar 

  25. Caos A, Benner KG, Manier J, McCarthy DM, Blessing LD, Katon RM, et al. Colonoscopy after Golytely preparation in acute rectal bleeding. J Clin Gastroenterol. 1986;8(1):46–9. Research Support, U.S. Gov’t, Non-P.H.S.

    Article  PubMed  CAS  Google Scholar 

  26. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342(2):78–82. Clinical Trial Research Support, U.S. Gov’t, P.H.S.

    Article  PubMed  CAS  Google Scholar 

  27. Bounds BC, Friedman LS. Lower gastrointestinal bleeding. Gastroenterol Clin North Am. 2003;32(4):1107–25. Review.

    Article  PubMed  Google Scholar 

  28. Steer ML, Silen W. Diagnostic procedures in gastrointestinal hemorrhage. N Engl J Med. 1983;309(11):646–50.

    Article  PubMed  CAS  Google Scholar 

  29. Chaudhry V, Hyser MJ, Gracias VH, Gau FC. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg. 1998;64(8):723–8.

    PubMed  CAS  Google Scholar 

  30. Pennoyer WP, Vignati PV, Cohen JL. Mesenteric angiography for lower gastrointestinal hemorrhage: are there predictors for a positive study? Dis Colon Rectum. 1997;40(9):1014–8.

    Article  PubMed  CAS  Google Scholar 

  31. Ponzo F, Zhuang H, Liu FM, Lacorte LB, Moussavian B, Wang S, et al. Tc-99m sulfur colloid and Tc-99m tagged red blood cell methods are comparable for detecting lower gastrointestinal bleeding in clinical practice. Clin Nucl Med. 2002;27(6):405–9. Comparative Study.

    Article  PubMed  Google Scholar 

  32. Beck DE, Margolin DA, Whitlow CB, Hammond KL. Evaluation and management of gastrointestinal bleeding. Ochsner J. 2007;7(3):107–13.

    PubMed  Google Scholar 

  33. Ng DA, Opelka FG, Beck DE, Milburn JM, Witherspoon LR, Hicks TC, et al. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. Dis Colon Rectum. 1997;40(4):471–7.

    Article  PubMed  CAS  Google Scholar 

  34. Hammond KL, Beck DE, Hicks TC, Timmcke AE, Whitlow CW, Margolin DA. Implications of negative technetium 99m-labeled red blood cell scintigraphy in patients presenting with lower gastrointestinal bleeding. Am J Surg. 2007;193(3):404–7. Discussion 7–8.

    Article  PubMed  Google Scholar 

  35. Schmulewitz N, Fisher DA, Rockey DC. Early colonoscopy for acute lower GI bleeding predicts shorter hospital stay: a retrospective study of experience in a single center. Gastrointest Endosc. 2003;58(6):841–6.

    Article  PubMed  Google Scholar 

  36. Ohyama T, Sakurai Y, Ito M, Daito K, Sezai S, Sato Y. Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding. Digestion. 2000;61(3):189–92.

    Article  PubMed  CAS  Google Scholar 

  37. Strate LL, Syngal S. Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol. 2003;98(2):317–22. Research Support, U.S. Gov’t, P.H.S.

    PubMed  Google Scholar 

  38. Imdahl A. Genesis and pathophysiology of lower gastrointestinal bleeding. Langenbecks Arch Surg. 2001;386(1):1–7. Review.

    Article  PubMed  CAS  Google Scholar 

  39. McGuire Jr HH. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg. 1994;220(5):653–6.

    Article  PubMed  Google Scholar 

  40. Wright HK, Pelliccia O, Higgins Jr EF, Sreenivas V, Gupta A. Controlled, semielective, segmental resection for massive colonic hemorrhage. Am J Surg. 1980;139(4):535–8.

    Article  PubMed  CAS  Google Scholar 

  41. Boley SJ, DiBiase A, Brandt LJ, Sammartano RJ. Lower intestinal bleeding in the elderly. Am J Surg. 1979;137(1):57–64.

    Article  PubMed  CAS  Google Scholar 

  42. Bender JS, Wiencek RG, Bouwman DL. Morbidity and mortality following total abdominal colectomy for massive lower gastrointestinal bleeding. Am Surg. 1991;57(8):536–40. Discussion 40–1.

    PubMed  CAS  Google Scholar 

  43. Almy TP, Howell DA. Medical progress. Diverticular disease of the colon. N Engl J Med. 1980;302(6):324–31. Review.

    Article  PubMed  CAS  Google Scholar 

  44. Laine L, Connors LG, Reicin A, Hawkey CJ, Burgos-Vargas R, Schnitzer TJ, et al. Serious lower gastrointestinal clinical events with nonselective NSAID or coxib use. Gastroenterology. 2003;124(2):288–92. Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t.

    Article  PubMed  CAS  Google Scholar 

  45. McGuire Jr HH, Haynes Jr BW. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg. 1972;175(6):847–55.

    Article  PubMed  Google Scholar 

  46. Lopez DE, Brown CV. Diverticulitis: the most common colon emergency for the acute care surgeon. Scand J Surg. 2010;99(2):86–9. Review.

    PubMed  CAS  Google Scholar 

  47. Klein RR, Gallagher DM. Massive colonic bleeding from diverticular disease. Am J Surg. 1969;118(4):553–7.

    Article  PubMed  CAS  Google Scholar 

  48. Wolff BG, Devine RM. Surgical management of diverticulitis. Am Surg. 2000;66(2):153–6. Review.

    PubMed  CAS  Google Scholar 

  49. Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH. Angiodysplasia. Clinical presentation and colonoscopic diagnosis. Dig Dis Sci. 1984;29(6):481–5. Comparative Study.

    Article  PubMed  CAS  Google Scholar 

  50. Boley SJ, Sammartano R, Adams A, DiBiase A, Kleinhaus S, Sprayregen S. On the nature and etiology of vascular ectasias of the colon. Degenerative lesions of aging. Gastroenterology. 1977;72(4 Pt 1):650–60.

    PubMed  CAS  Google Scholar 

  51. Bhutani MS, Gupta SC, Markert RJ, Barde CJ, Donese R, Gopalswamy N. A prospective controlled evaluation of endoscopic detection of angiodysplasia and its association with aortic valve disease. Gastrointest Endosc. 1995;42(5):398–402. Comparative Study.

    Article  PubMed  CAS  Google Scholar 

  52. Helmrich GA, Stallworth JR, Brown JJ. Angiodysplasia: characterization, diagnosis, and advances in treatment. South Med J. 1990;83(12):1450–3. Review.

    Article  PubMed  CAS  Google Scholar 

  53. Baum S, Athanasoulis CA, Waltman AC, Galdabini J, Schapiro RH, Warshaw AL, et al. Angiodysplasia of the right colon: a cause of gastrointestinal bleeding. AJR Am J Roentgenol. 1977;129(5):789–94. Research Support, U.S. Gov’t, P.H.S.

    Article  PubMed  CAS  Google Scholar 

  54. Olmos JA, Marcolongo M, Pogorelsky V, Herrera L, Tobal F, Davolos JR. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum. 2006;49(10):1507–16.

    Article  PubMed  Google Scholar 

  55. Nurnberg D, Pannwitz H, Burkhardt KD, Peters M. Gas explosion caused by argon plasma coagulation of colonic angiodysplasias. Endoscopy. 2007;39 Suppl 1:E182. Case Reports.

    Article  PubMed  Google Scholar 

  56. Manner H, Plum N, Pech O, Ell C, Enderle MD. Colon explosion during argon plasma coagulation. Gastrointest Endosc. 2008;67(7):1123–7. Review.

    Article  PubMed  Google Scholar 

  57. Chavalitdhamrong D, Jensen DM, Kovacs TO, Jutabha R, Dulai G, Ohning G, et al. Ischemic colitis as a cause of severe hematochezia: risk factors and outcomes compared with other colon diagnoses. Gastrointest Endosc. 2011;74(4):852–7.

    Article  PubMed  Google Scholar 

  58. Glauser PM, Wermuth P, Cathomas G, Kuhnt E, Kaser SA, Maurer CA. Ischemic colitis: clinical presentation, localization in relation to risk factors, and long-term results. World J Surg. 2011;35(11):2549–54.

    Article  PubMed  Google Scholar 

  59. Scharff JR, Longo WE, Vartanian SM, Jacobs DL, Bahadursingh AN, Kaminski DL. Ischemic colitis: spectrum of disease and outcome. Surgery. 2003;134(4):624–9. Discussion 9–30.

    Article  PubMed  Google Scholar 

  60. Cubiella Fernandez J, Nunez Calvo L, Gonzalez Vazquez E, Garcia Garcia MJ, Alves Perez MT, Martinez Silva I, et al. Risk factors associated with the development of ischemic colitis. World J Gastroenterol. 2010;16(36):4564–9.

    Article  PubMed  Google Scholar 

  61. Paterno F, McGillicuddy EA, Schuster KM, Longo WE. Ischemic colitis: risk factors for eventual surgery. Am J Surg. 2010;200(5):646–50. Comparative Study.

    Article  PubMed  Google Scholar 

  62. O’Neill S, Elder K, Harrison SJ, Yalamarthi S. Predictors of severity in ischaemic colitis. Int J Colorectal Dis. 2012;27(2):187–91.

    Article  PubMed  Google Scholar 

  63. Reissfelder C, Sweiti H, Antolovic D, Rahbari NN, Hofer S, Buchler MW, et al. Ischemic colitis: who will survive? Surgery. 2011;149(4):585–92.

    Article  PubMed  Google Scholar 

  64. Joainig MM, Gorkiewicz G, Leitner E, Weberhofer P, Zollner-Schwetz I, Lippe I, et al. Cytotoxic effects of Klebsiella oxytoca strains isolated from patients with antibiotic-associated hemorrhagic colitis or other diseases caused by infections and from healthy subjects. J Clin Microbiol. 2010;48(3):817–24. Comparative Study Research Support, Non-U.S. Gov’t.

    Article  PubMed  CAS  Google Scholar 

  65. Korkis AM, McDougall CJ. Rectal bleeding in patients less than 50 years of age. Dig Dis Sci. 1995;40(7):1520–3.

    Article  PubMed  CAS  Google Scholar 

  66. Alonso-Coello P, Mills E, Heels-Ansdell D, Lopez-Yarto M, Zhou Q, Johanson JF, et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101(1):181–8. Comparative Study Meta-Analysis Research Support, Non-U.S. Gov’t Review.

    Article  PubMed  Google Scholar 

  67. Salvati EP. Nonoperative management of hemorrhoids: evolution of the office management of hemorrhoids. Dis Colon Rectum. 1999;42(8):989–93. Lectures.

    Article  PubMed  CAS  Google Scholar 

  68. Su MY, Chiu CT, Wu CS, Ho YP, Lien JM, Tung SY, et al. Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids. Gastrointest Endosc. 2003;58(6):871–4.

    Article  PubMed  Google Scholar 

  69. Kanwal F, Dulai G, Jensen DM, Gralnek IM, Kovacs TO, Machicado GA, et al. Major stigmata of recent hemorrhage on rectal ulcers in patients with severe hematochezia: Endoscopic diagnosis, treatment, and outcomes. Gastrointest Endosc. 2003;57(4):462–8. Research Support, U.S. Gov’t, P.H.S.

    Article  PubMed  Google Scholar 

  70. Robert JR, Sachar DB, Greenstein AJ. Severe gastrointestinal hemorrhage in Crohn’s disease. Ann Surg. 1991;213(3):207–11.

    Article  PubMed  CAS  Google Scholar 

  71. Robert JH, Sachar DB, Aufses Jr AH, Greenstein AJ. Management of severe hemorrhage in ulcerative colitis. Am J Surg. 1990;159(6):550–5. Comparative Study.

    Article  PubMed  CAS  Google Scholar 

  72. Denton A, Forbes A, Andreyev J, Maher EJ. Non surgical interventions for late radiation proctitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev. 2002;1:CD003455. Review.

    PubMed  Google Scholar 

  73. Taylor JG, DiSario JA, Buchi KN. Argon laser therapy for hemorrhagic radiation proctitis: long-term results. Gastrointest Endosc. 1993;39(5):641–4. Research Support, U.S. Gov’t, Non-P.H.S.

    Article  PubMed  CAS  Google Scholar 

  74. Silva RA, Correia AJ, Dias LM, Viana HL, Viana RL. Argon plasma coagulation therapy for hemorrhagic radiation proctosigmoiditis. Gastrointest Endosc. 1999;50(2):221–4.

    Article  PubMed  CAS  Google Scholar 

  75. Hui AJ, Wong RM, Ching JY, Hung LC, Chung SC, Sung JJ. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc. 2004;59(1):44–8.

    Article  PubMed  Google Scholar 

  76. Rosen L, Bub DS, Reed 3rd JF, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993;36(12):1126–31. Review.

    Article  PubMed  CAS  Google Scholar 

  77. Yousfi M, Gostout CJ, Baron TH, Hernandez JL, Keate R, Fleischer DE, et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol. 2004;99(9):1785–9. Comparative Study.

    Article  PubMed  Google Scholar 

  78. Rex DK, Lewis BS, Waye JD. Colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage. Gastrointest Endosc. 1992;38(2):127–9.

    Article  PubMed  CAS  Google Scholar 

  79. Colon Cancer Screening (USPSTF Recommendation). US preventive services task force. J Am Geriatr Soc. 2000;48(3):333–5. Guideline Practice Guideline.

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Utah School of Medicine, 3B-202 SOM, 30 North 1900 East, Salt Lake City, UT, 84132, USA

    Tricia Hauschild M.D. & Daniel Vargo M.D., F.A.C.S

Authors
  1. Tricia Hauschild M.D.
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  2. Daniel Vargo M.D., F.A.C.S
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Correspondence to Daniel Vargo M.D., F.A.C.S .

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Editors and Affiliations

  1. Science Center, Department of Surgery, The University of Texas Health, 6431 Fannin Street, MSB 4.292, Houston, 77030, Texas, USA

    Laura J. Moore

  2. The Methodist Hospital, Department of Surgery, Weill Cornell Medical College, 6550 Fannin St, SM 1661A, Houston, 77030, Texas, USA

    Krista L. Turner

  3. School of Medicine, Department of Surgery, New York University, 550 First Avenue, New Bellevue 15 East 9, New York, 10016, New York, USA

    S. Rob Todd

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Hauschild, T., Vargo, D. (2013). Lower Gastrointestinal Bleeding. In: Moore, L., Turner, K., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6123-4_29

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